Organization
GOLDEN STATE DERMATOLOGY ASSOCIATES, INC.
Active
Organization
GOLDEN STATE DERMATOLOGY ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY THOMAS BORTZ M.D. (OWNER/MEDICAL DIRECTOR)
(925) 932-7704
Entity
Organization
Contact information
Practice address
355 LENNON LN STE 255, WALNUT CREEK, CA 94598-2496
(925) 932-7704
(925) 932-7752
Mailing address
370 N WIGET LN STE 250, WALNUT CREEK, CA 94598-2488
(925) 945-7005
(925) 954-1822
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D096539
CLIA NUMBER
CA
01
—
A487440
LICENSE
CA
Enumeration date
12/02/2005
Last updated
03/27/2026
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